Information Technology and Organizational Communication Literature Review

Information technology can be understood as the use of computerized and internet systems to process and distribute stored data and information in different forms, especially digital forms. “The idea that our society has begun an information revolution is a popular one. This information revolution is happening largely because the cost and capabilities of information
technology are rapidly changing” (Huff & Munro, 1985, p. 327). The information/com- munication world of the present age is desperately fast-paced and the struggle to stay ahead of competition and be in the market lead prompts many organizations to adopt emerging information technology systems to beat the limitations of time and space for improved practices and efficiency. We may explain therefore that information is passed through the means of communication and communication, if not well coordinated and properly transmitted, may result in misinterpretations, loss of information or equivocality. Simply put, we may say that the use of information technology helps to foster a better-organized system of communication within the society or organization as the case may be and when miscommunication is taken care of within an organization, most communication-induced problems are probably half-solved.
Organizational communication and its complexity therefore is described by Jehiel (1999) when he says, “In the organizational environment, we wish to address the question of how the transmission of the decentralized information should be organized so as to improve the efficiency of the decision-making.”(p. 660). Jehiel (1999) tries to explain in simpler terms how the process of communication within organizations takes place. Mostly, it takes a form in which strings of information are generated from various units and this information requires coordination and organization. The need for information technology comes into play at this point for the communication process to be properly organized into a wholesome meaningful piece without losing important information.
Hinds & Kiesler (1995, p. 373) state that “many large organizations have installed a complex network of computer-based technologies such as the telephone, facsimile, printing, voice mail, email, and even videoconferencing technologies. These technologies increase the potential for communication within the organization. They also support the changing dimensions of communication. Because technology reduces the cost and tendencies of unreliability of relaying orders, management can tighten control.” We can infer that information technology fosters collaboration and cooperation in team work for better and faster results thus eliminating bureaucratic hierarchical orders. Not only does the adoption of information technology in communication help to break the barriers of boundaries but it as well translates into having a diagonal direction of communication flow which is necessitated by the pressing demands of the situation at hand for a faster and more efficient approach to solutions.
Hinds and Keisler (1995, p.374) also opine that “employees who need to collaborate and share information will use communication technology to communicate across organizational boundaries.” They define crossing boundaries as “communicating non-hierarchically, that is, laterally, at the same level of the authority structure”, and “diagonally,” vertically outside the chain of command. “Communication technologies can be ranked by how well they suit collaboration, particularly the intense exchange of information required for planning and technical exchange” (Kraut, Egido, & Galegher, 1990).
“Organization scientists generally agree that there has been an evolution in organizational forms whereby managerial hierarchy and divisional structures are being replaced by decentralized, more flexible approaches to arranging and coordinating activities. Unlike its more rigid, bureaucratic predecessor, the new organizational forms are viewed as responsive to varied environmental pressures, including heightened market volatility, globalization of business, increased uncertainty, and demographic changes in labor and consumer sectors” (Fulk & Desanctis 1995, p.338). This might explain better to us why the adoption of technology by organizations are on the rise in the bid to keep up with the pace of advancement in the industry and probably set the pace as well.
Communication technologies avail their end users the vast range of opportunities to manipulate both the communication technologies themselves as well as the organizational contexts that surround them. As well, recent rises in communication technology adoption have been recognized as instrumental on organizational forms. “Early on, the rudimentary file system, interoffice memo, and business meeting contributed to the development of bureaucracies, enabling coordination and control among organizational components” (Yates 1989, p. 355, Yates & Orlikowski, 1992). “Later, telephones, telegraph, and mail systems enabled distributed forms of organization and inter-organizational communication. Organizational forms were designed to match communication needs”. (Fulk & DeSanctis, 1995, p. 337).
There are certain advantages of information technology that most likely propel its adoption. Fulk & Desanctis (1995) call this ‘new technology’, explaining that five features of new communication technologies offer important advancements for organizations. Of the five features identified, two features, time and space constraints management, have been mentioned while the other three identified by them are “the dramatic increase in the speed of communication, with high volumes of data moving from one location to another at rates unimaginable even a decade ago, the dramatic reduction in the costs of communication due to technical developments in computers and telecommunication technology and wider penetration of technology due to economies of scale” and the fact that “the integration of communication with computing technologies has moved communication technology beyond a purely connective function.” P. 337-8.
From the foregoing, we understand that the adoption of information technology for communication purposes within organizations has been inspired mostly by the range of flexibility and abilities it avails the organizational system itself especially in terms of getting more done in a better way, in less time if we might put it this way. We can then say that information technology eases the tedious and otherwise complex communication process.
“Current technology can affect not only how we communicate but also what we communicate. As a result, the issue for designers of communication support systems has become broader: how should technology be designed to make communication more effective by changing the medium and the attributes of the message itself? The answer to this question requires a shift from current preoccupations with the medium of communication to a view that assesses the balance between medium and message form. There is also a need to look more closely at the process of communication in order to identify more precisely any potential areas of computer support” (Te’eni Dov 2001, p.251). This creates the main crux of the investigation in this research work. Sarbaugh-Thompson and Feldman (1998) state that, “the adoption of a new medium for inter-organizational communication normally serves to increase rather than replace the communication via existing media.” p. 686. In other words, we might believe that the adoption of new technology was not in the bid to eliminate face-to-face interaction systems but to enhance and expedite it for faster responses.

We may want to note however, that non-verbal cues in communication may be lost with the adoption of new communication systems. For instance, in a face-to-face communication process, non verbal cues such as gestures, proxemics, occulesics, touch, etc. that usually foreground the intended meaning beyond mere spoken words especially in instances when the intended meaning transcends the literal interpretations may not be accessible when new technology replaces direct human interactions. In such situations, the interlocutors in communication may have to rely on the non-verbal cues to determine the interpretation and to act accordingly. Relating this to organizations, we might want to think therefore that, the adoption of social media in communication waters off the viability of the communicated message.
Rice (1992) states that “numerous studies have found that text-based computer- mediated communication systems are perceived as less appropriate for social, intuitive or emotional tasks that are difficult to analyze (such as negotiating) and more appropriate for less socio-emotional tasks that are more easily analyzed (such as exchanging information) (pp. 476– 7). Daft and Lewin (1993, p. iv) posit that, “Computer-mediated communication technology is becoming the backbone of many organizations, supplanting the formal hierarchical structure to achieve coordination and manage relationships within and between organizations. Electronic communications fuel the growth and effectiveness of an organization and its parts. Information, rather than being limited, controlled, and a source of power, appears to be instrumental for greater effectiveness when widely disseminated and freely available.” (p. iv). And Wiesenfeld, Raghuram, and Garud (1999) in a reflection of the statement above explain that advances in information technology have spurred emerging realities of work because organizations tend to experiment virtual ways of working.

Organizational Decision-making

We understand that many variables come into play in the decision-making process within organizations ranging from the style of leadership to the organizational culture that exists within the organization itself coupled with other factors such as information processing errors as
illustrated in the groupthink tendency model. “The outcomes of technological change are influenced by managerial choices, which themselves depend on a range of factors” (Clegg & Symon, 1991, p. 273).
Usually, an organization survives on the decisions made by some people within such organization. In other words, the decisions made by people in an organization and the choices they set affect an organization’s functions. Decision-making within organizations has been researched and understood from various perspectives ranging from emotional to unanimity and circular perspectives. A decision process can be illustrated as a string of actions and steps taken by stakeholders based on the important signals drawn from other stakeholders involved.
To better understand how a decision process goes through, a chain can be illustrated in stages as follows: at the first stage, the set of operating units is partitioned into subsets; in each subset there is a direct communication (to be collected by the representative of the subset, say the unit with the lowest index). At the second stage (if there is one), the representatives of the first-level groups are themselves partitioned into subsets with a direct communication taking place in each subgroup. In the final stage, all remaining representatives are engaged in a direct communication; the representative of the final group then transmits the output of the communication process to the decision maker. For each communication structure, one may infer the induced distribution of decision outcome. “The characterization of the optimal communication structures is a priori very complex because the set of all possible nested partitions of the type outlined above is very large” (Jehiel, 1999, p. 660).
Shoemaker, Kazley, and White, (2010) explain decision-making as the processes commonly portrayed as “occurring early in the “problem solving processes”-the sensing, exploration, and definition of problems or opportunities-as well as the generation, evaluation, and selection of solutions”. According to Feidbauer, Boan, Nadzam, Finis, and Nadzam (2008, p. 66), “an organization is at risk of making ill-advised design decisions if it approaches the decision-making process believing that clear and simple solutions will emerge from a quick or cursory review of the research findings.”
Janis (1989) also identified four contributory causes of unsuccessful outcomes of decision-making that could be outside the leaders’ control which include unforeseeable impediments to effective implementation, oversimplified beliefs that lead to erroneous assumptions, misleading information that the decision makers had no way of knowing was flawed, and unknown or chance factors commonly referred to as “bad luck.” However, Janis argues that one major cause of unsuccessful outcomes is within the leaders’ control: the poor quality of the decision-making process used either to arrive at the new policy decision or to reaffirm an existing policy. He states that although defective decision-making processes do not guarantee that a policy decision will have a negative outcome, the likelihood of failure is much higher.
Also closely linked to defective processes and poor outcomes of decisions is the leadership style that is practiced within an organization. Peterson (1997) opine that, “an open (nondirective) leadership style stimulates a greater exchange of ideas, which leads to greater use of information and more solutions being suggested than does a closed (directive) leadership style. An open leader was described as one who gives an opinion on an issue only after others have given theirs and one who encourages discussion of each potential solution” p. 1108.
On the other hand, a closed leader strongly advocates his/her position on the issue and does not encourage discussion of alternative ideas and solutions. “Leader defectiveness was closely associated with abbreviated group discussion, suppression of dissent, a less intensive search for information, and lack of contingency planning… leader defectiveness appears to be a potent cause of defective group process owing to a high likelihood of poor group
decisions….”(Peterson, 1997, p. 1108).

Shoemaker et al. (2010) explains the idea of a social constraint known as groupthink tendency that also has the potential of affecting the quality of decisions. He states as well that, when this constraint is dominant, the members engage in self-censorship of their doubts and opinions about the decision and defer to the position that seems to be preferred by the leader or the majority of the group” (Janis, 1989).
Further discussing the theory of the groupthink tendency, Janis (1989) explains that at the core of the groupthink theory is the assertion that the presence of certain antecedent conditions within groups of decision makers results in information-processing errors that in turn lead to poor-quality outcomes, as shown in the specification of groupthink model—causal chain is substantially reduced if sound procedures of information search, appraisal, and planning are used in the decision-making process. The groupthink model causal chain is categorized into three possible areas which are the antecedents of groupthink, information processing errors and outcomes.
The groupthink antecedents are such that can be understood as background catalysts that determine whether or not there will be errors in the information processing system. The antecedents include but are not limited to high personal stress, lack of tradition of impartial leadership, recent failure, group homogeneity, etc. These factors influence information processing in different forms such as omissions in objectives and poor information search. Ultimately, what results from the interaction between the groupthink antecedents and the information processing errors is a low probability of favorable outcomes.
Healthcare Organizations and Information Technology Adoption

Clegg and Symon (1991, p. 273) posit that “The most common rationale for the introduction of new technology in industry, it is claimed, is the belief that technology is intrinsically worthwhile and cannot fail to bring economic benefits…Companies which do not invest in the latest advanced technology will suffer in consequence (e.g. ‘automate or liquidate’)…technology is used by management to minimize skill levels, reduce costs and maintain control over the workforce. This is interpreted as the driving force behind the design of progressively more automated manufacturing processes.”
Cohn, K. et al. (2009) explain that Healthcare information technology (HIT) is one of the most expensive capital investments for any healthcare organization. HIT adoption is a complex process because adoption and implementation depend on buy-in from physicians, most of whom are not employed by the organization and whose thinking varies widely. He also states that HIT comprises systems such as the electronic medical record, computerized physician order entry, and decision support systems that integrate and improve access to health- and patient-related data.
Advantages of adopting information technology in healthcare systems administration, from the economic point of view as stated by Cohn, K. et al. (2009), include the opportunity for patient-physician partnership, decision support for clinicians and physicians who face myriad

clinical challenges, access to and storage of medical and patient information, ability to retrieve and store vital information, which allows patients to be notified of medication recalls, side effects, and interactions, reduction in filing, transcription, and staffing costs, decreased duplication, improved coding accuracy and revenue capture.
From the foregoing, we understand that information technology adoption in organizations presents itself more as a necessity rather than a luxury when analyzed from both the work- oriented and economic perspectives.
Theoretical Framework

Though there are several frameworks and theories applied to the study of adoption of technology in healthcare organizations, the theoretical frameworks within which this study is situated are the diffusion of innovation theory, which will explain the adoption process and influencing factors for the adoption of the technology used by the organization under study. The other framework is the technology acceptance model which will illustrate how perceived ease and usefulness are factored in as the decision-making process to adopt or not to adopt the technology in use by the organization under study. The third framework is the theory of reasoned action and planned behavior that explain reinforcement of behavior and attitudinal dispositions and how it affects the decision to adopt or not to adopt a technology. Gagnon et al. (2010) claim that the Diffusion of Innovation (DOI) has been the center of much attention in the study of ICT adoption in the healthcare industry. They claim that the diffusion of innovations model points out three main sources influencing the adoption and diffusion of an innovation, which are the perceptions of
innovation characteristics, characteristics of the adopter, and contextual factors. “This model has been applied to study the adoption of various information technologies in healthcare. However, the DOI does not provide information on how to assess innovation characteristics” (P.3). Other identified models include the technology acceptance model which was specifically developed to understand user’s acceptance of information technology, the theory of reasoned action, the theory of planned behavior, etc. The media richness theory also explains the effects of the medium of communication employed and the ability of communication to change in meaning based on this.
Diffusion of Innovations Theory

We might understand innovation as an act of introducing something new or doing something in a new way and Rogers (2003) and Morris and Ogan (1996, p. 41) state that, “Diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system (Rogers, 2003). An innovation is an idea, practice, or object perceived as new by an individual or other unit of adoption. The diffusion process typically
involves both mass media and interpersonal communication channels. And, in today’s world, information technologies such as the Internet and cell phones – which combine aspects of mass media and interpersonal channels, represent formidable tools of diffusion” (Morris & Ogan, 1996:41).

Diffusion of Innovation Model. Source: Rogers (1995).

In the diffusion model the aspects key to our study are the perceived characteristics of innovation and the decision-making process that is initiated by the knowledge stage up to the final stage of confirmation and probable reinforcement.
Rogers et al. (2009) also claim that, “Although most observers agree that the diffusion of innovations is fundamentally a communication process. Communication scholars constitute only one of the dozen research traditions presently advancing the diffusion field (along with geography, education, marketing, public health, rural sociology, agricultural economics, general economics, political science, and others). Other communication research areas such as persuasion and attitude change and mass communication effects also began prior to the
institutionalization of communication study in university units”(p. 4). This clearly explains that diffusion of innovation is not limited to the field of communication studies only but as well applies to others areas of human endeavor and study as listed above.
Rogers (1983) also believes that it matters little, so far as human behaviour is concerned, whether or not an idea is “objectively” new as measured by the lapse of time since its first use or discovery. The perceived newness of the idea for the individual determines his or her reaction to it. If the idea seems new to the individual, it is an innovation…newness in an innovation need not just involve new knowledge. Someone may have known about an innovation for some time but not yet developed a favorable or unfavorable attitude toward it, nor have adopted or rejected it. The “newness” aspect of an innovation may be expressed in terms of knowledge, persuasion, or a decision to adopt. From the foregoing, we can say that when a thing or invention is conceived does not determine its newness as an innovation and therefore, an innovation is regarded as new at the point in time when an individual finds out about it. This brings us to the categorization of innovation adapters and certain factors and characteristics of innovations which

are responsible for/influence the category an individual adapter of innovation falls into depending on their perception, which includes the following as identified by Rogers (1983).

1. Relative advantage: this is the degree to which an innovation is perceived as better than the idea it supersedes. This may be measured in economic terms but social-prestige factors, convenience, and satisfaction are also often important components. It does not matter so much whether an innovation has a great deal of “objective” advantage. What does matter is whether an individual perceives the innovation as advantageous. The greater the perceived relative advantage of an innovation, the more rapid its rate of adoption is going to be.
2. Compatibility: this is the degree to which an innovation is perceived as being consistent with the existing values, past experiences, and needs of potential adopters. An idea that is not compatible with the prevalent values and norms of a social system will not be adopted as rapidly as an innovation that is compatible. The adoption of an incompatible innovation often requires the prior adoption of a new value system.
3. Complexity which explains the degree to which an innovation is perceived as difficult to understand and use. Some innovations are readily understood by most members of a social system; others are more complicated and will be adopted more slowly…new ideas that are simpler to understand will be adopted more rapidly than innovations that require the adopter to develop new skills and understandings.
4. Trialability is the degree to which an innovation may be experimented with on a limited basis. New ideas that can be tried on the installment plan will generally be adopted more quickly than innovations that are not divisible.
5. Observability: the degree to which the results of an innovation are visible to others.

The easier it is for individuals to see the results of an innovation, the more likely they are to

adopt. Such visibility stimulates peer discussion of a new idea, as friends and neighbors of an adopter ask him or her for innovation-evaluation information about it.
For the purpose of this study, the diffusion of innovations theory will help us shed light on the most likely influencing factors for the adoption and use of information technology in health organizations. This study will be explaining the characteristics of innovation as listed above by Rogers (1983) vis-a-vis the responses of participants in the interviews conducted for the purpose of this study to explain the guiding principles for the decision to adopt certain information technology within their organization. This will answer the second research question that says “What influences the decision to adopt a communication technology most according to the company’s top management?”
Also, the innovation decision process explained by Rogers (1983) involves the process through which an individual passes from first knowledge stage of an innovation to forming an attitude towards it, to a decision to adopt or reject, to implementation of the new innovation, and to confirmation or reinforcement of this decision. Five stages of innovation adoption process are identified as follows:
Awareness or knowledge stage which is the stage when an individual gets to know about the existence or functionality of a particular invention. We conceptualize five main steps.

1. The persuasion stage is the stage at which the individual develops either a pleasant/welcoming attitude to the innovation or not.
2. The decision stage is the point at which based on the disposition of the individual towards the innovation, a choice is made to either adopt or reject the innovation.
3. At the implementation level, the decision to use an innovation has been made and is being actualized/evaluated in real-world use and practice and this determines if there

will be a re-invention or reinforcement based on the level of satisfaction derived from the use of such innovation.
Against the backdrop of the fact that information technology is perceived as an innovation with its own elements and tools of diffusion, this study will be establishing the innovation decision process as it applies to the organization of the organization used as case study in this study. Rogers explains also that there are three types of innovation decisions which are optional, collective and authority innovation decisions which will be used as yardsticks to identify the type of decision process employed in our case study organization. The optional innovation decision is explained as the decision or choice to adopt or reject an innovation made by an individual independent of/ without the consent of the other members of the system.
The collective innovation decision system involves a consensus among members of the system such that when the decision is made it has to be adhered to while the authority innovation decision is such that allows a few individuals who possess power and expertise to make decisions and a single individual within the system cannot influence the decisions otherwise.
This idea will be investigated in this study to address the third research question that asks “How is the decision to adopt a communication technology made by the company’s top
management?”

Technology Acceptance Model

The technology acceptance theory attempt to model how users of technology come to accept and put into use a technology based on their perception of its usefulness and ease of use. The perceived usefulness otherwise known as PU explains how much a user believes that a technology is needed in enhancing his or her performance and output on their job and PEOU— i.e., perceived ease of use has to do with how much the technology eliminates difficulty in its application. In other words, PEOU has to do with the ease or effortlessness of the use of such technology otherwise termed as performance expectancy and effort expectancy. These two factors, which are the yardstick with which this study will answer the first research question that asks how effectiveness is defined by the top management, influence the decisions of users to adopt or not to adopt a technology for use. The theory of technology acceptance model developed by Fred Davis (1989) is an extension of the theory of reasoned action (TRA).
Legris et al. (2003, p. 192) state that “Davis and Davis et al. proposed TAM to address why users accept or reject information technology. Their model is an adaptation of the theory of reasoned action proposed by Fishbein and Ajzen to explain and predict the behaviors of people in a specific situation. A key purpose of TAM is to provide a basis for tracing the impact of external variables on internal beliefs, attitudes, and intentions. It suggests that perceived ease of use (PEOU), and perceived usefulness (PU) are the two most important factors in explaining system use,” p. 192.

Technology Acceptance Model. Source: Davis (1989).

The claim of the technology acceptance model is that external variables identified as PU and PEOU are the main determinants of an individual’s decision to adopt a technology and actually use it. In other words, these two variables which are considered the external variables

influence the behavioral intentions of a user and ultimately determine if the technology system will be put into actual use or not.
Going by this proposition of the technology acceptance model, the fourth research question addressed in this study asks “Do the communication software adopted work efficiently according to expectations?” In other words, the question investigates whether the software adopted is perceived as working up to expectations. This is addressed based on the claims of this model of acceptance. This theory notably suggests a feature of voluntariness which means that use or decision to use an information systems or technology is made non-mandatory and subject to certain pre-considerations before a decision is made.
Theory of Reasoned Action and Theory of Planned Behavior

Galletta and Malhotra (1999) claim that the theory of reasoned action (TRA) as a widely-studied model from social psychology is mainly “concerned with the determinants of consciously
intended behaviors. According to TRA, a person’s performance of a specified behavior is determined by his or her behavioral intention (BI) to perform the behavior, and BI is jointly determined by the person’s attitude (A) and subjective norm (SN) concerning the behavior in question. TAM uses TRA as a theoretical basis for specifying causal linkages between two key sets of constructs: (1) Perceived Usefulness (PU) and Perceived Ease of Use (PEOU), and (2)
user’s attitude (A), behavioral intentions (BI) and actual computer usage behavior….”The theory of planned behavior on the other hand serves as a missing link between pre-conceived beliefs and resultant behaviors and according to Venkatesh et al. (2003) it “extended TRA by adding the construct of perceived behavioral control. In TPB, perceived behavioral control is theorized to be an additional determinant of intention and behavior…”Venkatesh et al. (2003:430) also claim that “TPB has been successfully applied to the understanding of individual acceptance and usage of many different technologies”. Venkatesh (2003) claim that “Voluntariness was not included in the original TPB…As noted in the discussion regarding TRA, although not tested, subjective norm was suggested to be more important when system use was perceived to be less voluntary….” p. 430.
Finding the baseline correlation between these two intertwined theories can be explained by the understanding that while the theory of reasoned action implies that the behavior of a system user or an individual is defined and decided by a pre-conceived intention to perform the behavior. This premeditated intention is a result of a pre-existing attitude. Simply put therefore, the intention predicts the action/behavior’ intentions are the real actions catalysts.
The relevance of these theories is intended to be reflected in the analyses of responses to questions that address the research question of what influences the decision to adopt a communication software/technology.
Setting: Alpha+ Healthcare Solutions

For the purpose of this research, the selected organization’s identity will be protected under the pseudonym “Alpha+ Healthcare Solution, Limited Liability Company. This is a young, vibrant, and dynamic private homecare health services provider with its main office located in the state of Georgia. The company was established to meet the need for a viable, cost effective, and beneficial alternative to institutional healthcare. The healthcare company can be regarded as a “one stop solution center” that is also licensed by the state of Georgia to provide skilled nursing and personal care services. The company is qualified to provide various skilled nursing and medically related activities, companion sitter, in-home respite, homemaker and personal care services as mandated by the Department of Human Resources and Public Health. The company employs only licensed healthcare professionals certified by the state of Georgia with a minimum of two years of work experience. In-depth orientation is conducted through qualified personnel, and current health status of each healthcare professional is checked before their first assignment. Criminal background check and references check records on all staff are also duly conducted. All staff have CPR certification, are equally bonded, and possess other professional certifications and licenses required by the state of Georgia. The services of Alpha+ Healthcare Solution, LLC are provided across 12 coverage regions within the state of Georgia.
The company has approximately about 200 medical employees on field and about 15 other employees in the main office. It is headed by the Chief Executive officer who oversees the operations, business development, clinical, marketing research and sales and administrative functions while the Chief Financial Officer handles financial management records, billings, training and development, purchasing and inventory, payroll and recruiting issues. The project manager reports directly to the CEO and the CFO because his duties fall under both categories
i.e. administrative and financial. The CEO coordinates the intake coordinator, the quality assurance Nurse manager and the clinical nurse manager who all report to her office. The quality assurance manager is responsible for assessment nurses and the field nurses (registered nurses and licensed practitioner nurses) while the clinical nurse manager is responsible for the scheduling coordinator and operations support coordinator.
On the other hand, the CFO who also doubles as the HR director oversees the accountant, the account receivable coordinator and the office manager. The office manager is also responsible for the admin and payroll assistant.